For most bone fractures, it is sufficient to apply a plaster cast. The fracture ends then grow together on their own. However, in the case of more complicated fractures, it is often necessary to fix the fracture ends with screws, wires, nails and metal plates. Only then can they grow back together properly. These stabilization procedures are summarized under the generic term osteosynthesis.
Here you will find further information as well as selected osteosynthesis specialists and centers.
The term osteosynthesis can be translated most simply as bone fusion. Various surgical procedures are used for this purpose. After bone fractures, they serve to stabilize the bone as a whole.
A bone loses stability as a result of a fracture. During everyday movements, the fracture sites can shift again and again and therefore not heal properly. Osteosynthesis is intended to remedy this situation.
The aim of an osteosynthetic procedure is to reattach the broken pieces of bone to their original shape. At the same time, it is also intended to stabilize the fracture site.
The following procedures achieve osteosynthesis:
The procedure chosen depends on the individual case, in particular the location of the fracture and its exact type.
Surgical treatment is not necessary for all fractures. However, osteosynthesis is recommended for the following conditions
Basically, human bone consists of
Large bones also have a medullary cavity inside them, in which the bone marrow is located. With increasing age, however, the bone marrow is increasingly replaced by fat.
Finally, the bone is enveloped by the periosteum, the bone skin.
Before the actual procedure, the fragments on the bone must first be brought back into the correct shape. This step is known as reduction.
In many cases, this does not even require surgery. The doctor can bring the fragments back into their original position simply by moving and pulling them.
If this is not possible, or if the fracture is complicated, the reduction is carried out during the operation.
The doctor drills a hole in the cortex of the bone to accommodate a screw. A slightly smaller hole is drilled directly opposite this fracture, into which the doctor cuts the thread for the screw.
When the screw is screwed into the holes, the two bone fragments are pressed firmly together.
The cancellous bone screw has a long shaft with a short thread at the lower end. Here too, the surgeon drills a hole in the bone through which the screw shaft can slide. The screw is then turned into the drilled hole so that the thread is behind the fracture line.
Here, too, traction is created which presses the fracture pieces firmly together.
The doctor first exposes the bone at the fracture site. He then selects a plate that fits the surface of the bone in terms of shape and size. The plate is placed over the fracture line and fixed to all fragments of the bone with screws.
In this procedure, the plate provides a firm connection.
This elbow fracture is fixed using plate osteosynthesis © stockdevil | AdobeStock
In intramedullary nail osteosynthesis, the doctor opens the medullary cavity of the bone with an awl or wire. The medullary cavity is then widened and a nail is hammered in, which should bridge the fracture space significantly. In a way, it represents an internal splint.
To prevent the nail from moving, a cross pin is driven into the bone if necessary (locking nail).
In this procedure, the fracture site is bridged with elastic steel wires. The doctor drives them through the bone cortex and sinks them into the cancellous bone.
However, the upper part of the wire should remain outside the bone. This allows it to be easily removed once the fracture has healed.
This method is particularly suitable for fractures in smaller bones or a fracture in the growth plates. This procedure is also often used for collarbone fractures.
In this procedure, the tensile forces that pull the fracture pieces apart are converted into compressive forces. The surgeon first inserts two wires, which run parallel to each other and perpendicular to the fracture gap, into the bone. He then places a soft wire loop around both wires. This is pushed through a channel into the bone so that it is taut.
An external frame is used to hold the bones in position. Small incisions are first made in the patient's skin. The doctor drills small holes in the broken bone through these incisions.
He then attaches metal rods and connects them with metal struts. This stabilizes the fracture site.
This procedure is very suitable for fractures of the neck of the femur.
A guide wire is inserted into the part of the femoral neck that is close to the hip joint. A screw with a short, thick thread is then screwed into the hip button. Finally, a metal plate is screwed to the outside of the femur.
Over the following weeks, the fracture gap is compressed by the patient's body weight alone.
As soon as the osteosynthesis has been inserted, the doctor sutures the muscles and the connective tissue of the skin. He then applies a wound dressing.
Patients do not need to take any special precautions after the procedure itself.
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